COVID-19 and CLL: A Spanish Perspective
Posted: Wednesday, January 27, 2021
Patients with chronic lymphocytic leukemia (CLL) who contracted COVID-19 had a case fatality rate of 33.6%, and patients with more comorbidities and/or higher levels of inflammatory markers had higher rates of mortality. These results were published by Ana Muntañola, MD, of the Hospital Universitari Mútua Terrassa, Barcelona, and colleagues in Experimental Hematology and Oncology.
A population of 165 patients with CLL and COVID-19 across 40 Spanish centers were identified between March 1, 2020, and May 31, 2020. The median age at the time of infection was 73 years, and 40% of patients had multiple comorbidities. Patients were in various stages of CLL treatment; 52% were “watch and wait,” 21% had been previously treated, and 28% were in current treatment. The most common CLL-directed therapies in this cohort were Bruton’s tyrosine kinase Inhibitors (n = 34) and venetoclax (n = 7). C-reactive protein levels were elevated above 0.3 mg/mL in 27.8%, D-dimer levels were elevated above 500 mg/mL in 70%, ferritin levels were above 400 mg/mL in 74%, and interleukin-6 levels were elevated in 88%.
A total of 45 deaths were noted, all of which were secondary to COVID-19, making the case fatality rate approximately 33.6%. The overall survival estimate at 28 days was 74.1%. Lymphocytosis (white blood cell count > 30 × 109/L) and elevated D-dimer levels were associated with a decrease in overall survival (hazard ratio = 1.96 and 4.35, respectively). Patients in the watch-and-wait group had a similar overall survival as those receiving active CLL treatment.
Overall, patients with CLL had higher COVID-19 mortality rates when compared with patients without malignancy or another type of immunosuppression (odds ratio = 1.74). This increased mortality was particularly notable among patients with CLL younger than 60. This younger subgroup had a COVID-19 mortality rate of 16.7%, compared with 0.7% in the control group.
Disclosure: The authors reported no conflicts of interest.
